Abstract: Exosomes are membranous vesicle-like microbodies secreted from cells. Exosomes have application value in the diagnosis and treatment of orthopedic degenerative diseases, mainly osteoarthritis and intervertebral disc degeneration. Exosomes of various cell sources, including mesenchymal stem cell (MSC), can inhibit chondrocyte degeneration and promote regeneration. Among them, MSC derived-exosomes are the most widely studied, which have the advantages of abundant cell resources, high yield, and easy access. The expression profile of microRNAs (miRNA) in chondrocyte exosomes is significantly different from that of its parent cells, suggesting that exosomes secreted by chondrocytes play an important role in chondrogenic differentiation and maintenance of chondrocyte homeostasis. In addition, exosomes derived from normal nucleus pulposus cells can induce migration and differentiation into nucleus pulposus cells of MSC. In some cases, exosomes from synovial fibroblasts under inflammatory microenvironment may also be a contributing factor for the cartilage degeneration. This article reviews the studies on exosomes from different cell sources in orthopedic degenerative diseases, which might bring new ideas for the diagnosis and treatment of these diseases.